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Old 05-23-2019, 02:19 PM
 
231 posts, read 151,648 times
Reputation: 718

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I went for my Welcome to Medicare visit and the doc referred me for a mammogram, blood test, but also a screening test for bone density (dexa, I think it's called). She said at 65 Medicare will cover this test for screening/preventative. I looked at the Medicare website and it said:
Bone mass measurements
Medicare Part B (Medical Insurance) covers this test once every 24 months (or more often if medically necessary) if you meet one of more of these conditions:
You’re a woman whose doctor determines you’re estrogen deficient and at risk for osteoporosis, based on your medical history and other findings.
Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.
You’ve been diagnosed with primary hyperparathyroidism.
You’re being monitored to see if your osteoporosis drug therapy is working.

None of these qualifications apply to me. I don't have any reason to believe I have any issues related to bone density.

Has anyone here had that test covered by Medicare Part B with no risk factors?
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Old 05-23-2019, 03:08 PM
 
Location: Bella Vista, Ark
77,813 posts, read 91,585,335 times
Reputation: 48828
Quote:
Originally Posted by PNW to NEPA View Post
I went for my Welcome to Medicare visit and the doc referred me for a mammogram, blood test, but also a screening test for bone density (dexa, I think it's called). She said at 65 Medicare will cover this test for screening/preventative. I looked at the Medicare website and it said:
Bone mass measurements
Medicare Part B (Medical Insurance) covers this test once every 24 months (or more often if medically necessary) if you meet one of more of these conditions:
You’re a woman whose doctor determines you’re estrogen deficient and at risk for osteoporosis, based on your medical history and other findings.
Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.
You’ve been diagnosed with primary hyperparathyroidism.
You’re being monitored to see if your osteoporosis drug therapy is working.

None of these qualifications apply to me. I don't have any reason to believe I have any issues related to bone density.

Has anyone here had that test covered by Medicare Part B with no risk factors?
I have had 2 tests done: both were covered 100%
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Old 05-23-2019, 03:56 PM
 
231 posts, read 151,648 times
Reputation: 718
Quote:
Originally Posted by nmnita View Post
I have had 2 tests done: both were covered 100%
Did you have any of the listed risk factors when referred by your doctor?
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Old 05-23-2019, 04:07 PM
 
Location: Alexandria, VA
12,610 posts, read 22,556,965 times
Reputation: 19494
Sadly, Medicare set an age (older than I am) to start paying for a DEXA scan - I'm on Medicare due to disability and previously, yrs. ago had scans that showed osteopenia, took meds. for a while but didn't want to continue. Not sure why Medicare decides to wait until a certain age when someone has factors: small boned, female, ethnicity, etc. - seems like they would want to stay on top of things, but no............
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Old 01-24-2020, 07:25 AM
 
8,531 posts, read 5,034,694 times
Reputation: 18191
Quote:
Originally Posted by PNW to NEPA View Post
I went for my Welcome to Medicare visit and the doc referred me for a mammogram, blood test, but also a screening test for bone density (dexa, I think it's called). She said at 65 Medicare will cover this test for screening/preventative. I looked at the Medicare website and it said:
Bone mass measurements
Medicare Part B (Medical Insurance) covers this test once every 24 months (or more often if medically necessary) if you meet one of more of these conditions:
You’re a woman whose doctor determines you’re estrogen deficient and at risk for osteoporosis, based on your medical history and other findings.
Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.
You’ve been diagnosed with primary hyperparathyroidism.
You’re being monitored to see if your osteoporosis drug therapy is working.

None of these qualifications apply to me. I don't have any reason to believe I have any issues related to bone density.

Has anyone here had that test covered by Medicare Part B with no risk factors?
I'd think that any woman over 65 who is not taking hormones would qualify for the "whose doctor determines you're estrogen deficient and at risk for osteoporosis" restriction. Because any woman over 65 WOULD be estrogen deficient, if she wasn't taking hormones currently or recently.
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Old 01-24-2020, 08:03 PM
 
209 posts, read 118,785 times
Reputation: 1107
I was referred for a DEXA scan at my Welcome to Medicare visit. I don't have any pre-existing conditions or prior bone issues, but it was fully covered by Medicare. Just being female and 65 is sufficient. Your doc needs to code it as "asymptomatic post-menopausal" or some words to that effect.
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Old 01-25-2020, 10:21 PM
 
8,531 posts, read 5,034,694 times
Reputation: 18191
Quote:
Originally Posted by Jessie Mitchell View Post
I was referred for a DEXA scan at my Welcome to Medicare visit. I don't have any pre-existing conditions or prior bone issues, but it was fully covered by Medicare. Just being female and 65 is sufficient. Your doc needs to code it as "asymptomatic post-menopausal" or some words to that effect.
I guess Medicare just sticks to the rules, where I'm concerned. This has happened to me all my life, it seems.

Medicare did not approve my blood test, because that's for a well exam, which Medicare insureds can't get until their 2nd year. Same for any other test that is for a well exam rather than a "welcome to Medicare" exam. My pamphlet says they'll pay a doctor visit for a "welcome to Medicare" visit, but can't get a well exam & tests until the next year.

So I put off getting the bone density & mammogram until a week ago, so hopefully it will be covered.

I even got an email from Medicare beg. of January that says, "Congratulations! Now that you've been enrolled in Medicare a full 12 months, you now qualify for well exams!"

(If it's in the rules, I think there's an asterisk next to "this applies only to Bpollen.")

I haven't rec'd a bill for the path lab yet, so I don't know if they re-coded & sent it back to Medicare or what. I doubt the lab would eat that cost. Maybe it takes them this long to send out a bill after Medicare rejection. I didn't want to ask the dr office & stir the pot.
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Old 01-26-2020, 04:18 PM
 
8,531 posts, read 5,034,694 times
Reputation: 18191
Quote:
Originally Posted by Jessie Mitchell View Post
I was referred for a DEXA scan at my Welcome to Medicare visit. I don't have any pre-existing conditions or prior bone issues, but it was fully covered by Medicare. Just being female and 65 is sufficient. Your doc needs to code it as "asymptomatic post-menopausal" or some words to that effect.
Hopefully, that will cover a DEXA scan the 1st year. Anyway, putting it off a few months didn't hurt, just in case.

Maybe that IS the difference: I was low on Vitamin D, and not on hormones.

Anyway, it's been done, now. And I DO have osteopenia. Well, I think all women over 60 have some degree of low bone mass compared to a 30 yr old. Osteopenia is not a medical condition, I read. But it's low enough so that I need to do something about it.
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Old 01-26-2020, 05:17 PM
 
209 posts, read 118,785 times
Reputation: 1107
I had "mild osteopenia" in one femur, but the other was okay and spine was okay. I started taking a D supplement and also K, and added a calcium supplement. Not sure why one femur would be okay and the other low... but as in your case, it's nothing severe and not even really a disease. I've always done pretty heavy weight bearing exercise so can't really change anything there. My mom lived to 93 and her bones held out well, so I'm not going to fret about it. Good to know, though.
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Old 02-24-2020, 11:50 AM
 
1,616 posts, read 1,438,005 times
Reputation: 2589
Quote:
Originally Posted by bpollen View Post
I guess Medicare just sticks to the rules, where I'm concerned. This has happened to me all my life, it seems.

Medicare did not approve my blood test, because that's for a well exam, which Medicare insureds can't get until their 2nd year. Same for any other test that is for a well exam rather than a "welcome to Medicare" exam. My pamphlet says they'll pay a doctor visit for a "welcome to Medicare" visit, but can't get a well exam & tests until the next year.

So I put off getting the bone density & mammogram until a week ago, so hopefully it will be covered.

I even got an email from Medicare beg. of January that says, "Congratulations! Now that you've been enrolled in Medicare a full 12 months, you now qualify for well exams!"

(If it's in the rules, I think there's an asterisk next to "this applies only to Bpollen.")

I haven't rec'd a bill for the path lab yet, so I don't know if they re-coded & sent it back to Medicare or what. I doubt the lab would eat that cost. Maybe it takes them this long to send out a bill after Medicare rejection. I didn't want to ask the dr office & stir the pot.
First you get a Welcome to Medicare exam. After you have had that exam, go back to your doctor and then they can order bloodwork or any other test. You just have to have a separate exam done. I have been to my primary as well as 3 specialist, and everything was covered. All my bloodwork too.
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